Executive Summary

Place matters for health in important ways. Research demonstrates that neighborhood conditions—the quality of public schools, housing conditions, access to medical care and healthy foods, levels of violence, availability of exercise options, exposure to environmental degradation—powerfully predict who is healthy, who is sick, and who lives longer. And because of patterns of residential segregation, these differences are the fundamental causes of health inequities among different racial, ethnic, and socioeconomic groups. This study examines the relationships between health, community characteristics, and food access in Cook County, IL, and attempts to address specific questions raised by the Cook County Place Matters Team:

What is the relationship between community-level measurements of socioeconomic status—that is, wealth, income, and/or education—and access to healthy food?

What is the relationship between access to nutritious food and the amount spent for nutritious food?

What is the relationship between access to different types of food providers and health outcomes?

The study drew the following conclusions:

Between 2005 and 2009, the Index of Dissimilarity for Cook County between the black and white populations was 80.8% at the census tract level.5 The higher the index, the more segregated the area. The Index of Dissimilarity between white and Hispanic populations in Cook County was 60.2%,6 which is similar to the state index.

Cook County is segregated by race and class, as shown in Maps 2 and 3, while pockets of poverty exist throughout the county.

Educational opportunities and attainment are stratified by race and ethnicity.

More than a quarter of Cook County census tracts experience persistent poverty, meaning that at least 20% of households have been in poverty for two decades; 162 census tracts have had at least 20% of residents in poverty for five decades.

In Cook County in 2007 the premature death rate for black residents was 445.9 per 100,000 persons; for white residents the rate was 179.5; for Hispanic residents it was 141.3.

People living in areas with a median income greater than $53,000 per year had a life expectancy that was almost 14 years longer than that of people living in areas with a median income below $25,000 per year.

Most of the census tracts with low educational attainment and low food access are located in the southern portion of Cook County, which has a high concentration of minority communities.

Residents in the quintile with the least access to chain supermarkets and large independent grocers have an average life expectancy that is approximately 11 years shorter than residents in the quintile with the highest access to such food providers.

The overall pattern suggests that socioeconomic conditions in neighborhoods of concentrated poverty, which are predominantly African American and Latino, make it more difficult for people in these communities to live healthy lives. It is unacceptable in the world’s wealthiest society that a person’s life can be cut short by more than a decade simply because of where one lives and factors over which he or she has no control. Clearly, there is a strong moral imperative to enact policies to redress the inequities of the past, as well as current inequities, in ways that will improve health for all. But, there also is a powerful economic incentive. A study released by the Joint Center for Political and Economic Studies in 2009 found that direct medical costs associated with health inequities among African Americans, Hispanics, and Asian Americans approached $230 billion between 2003 and 2006. When indirect costs, such as lowered productivity and lost tax revenue resulting from illness and premature death, were included, the total cost of health inequities exceeded $1.24 trillion.7 Thus, for both moral and economic reasons, we must address health inequities and their root causes now.

Recommendations

In “Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health,” issued in 2008, the World Health Organization called for three changes to eliminate health inequities. These changes serve as a framework for the following specific policy recommendations, some of which may be outside the scope of this report, which focuses on access to food and food justice. However, the Place Matters Team hopes that these recommendations will help to guide champions of health equity in metropolitan Chicago as they seek to influence change at the applicable level of government— municipal, county, state, and federal.

1. Implement the World Health Organization recommendations

Improve daily conditions.

Tackle the inequitable distribution of power, money, and resources.

Measure and understand the problem and assess the impact of action.

2. Track health inequities

Health departments and other agencies should monitor health inequities and make the data available to the public. Health departments need to have funding adequate to the task of collecting, analyzing, and presenting data related to inequities. Health departments need infrastructure and capacity sufficient to draft and implement actions to address health inequities. Local health departments should have sufficient capacity to conduct Health Impact Assessments.

Race/ethnicity/class/gender data should be collected to monitor health inequities.8

Funding for the U.S. Census and the American Community Survey should be strengthened.

Investigate a classification system for restaurants by service level that would allow for a clearer mapping of all (rather than just chain) restaurants by type.

Fund local health departments to perform a nutrition survey of a sample of restaurants and other food retail outlets in low- and high­food-access communities.

4. Implement a public financing program to provide financial “seed money” to stimulate healthy food retail in neighborhoods with low food access

The state of Illinois should create a financial seeding agency to raise capital to invest in communities.

Sufficient funds should be available to address the need for increased food retail outlets in the entire Chicago metro area.

A broad range of food retail outlets should be eligible for funding, including small stores, co-ops, and nonprofit enterprises.

Multiple options are needed to increase access to food:

Promote the development of a variety of small and large innovative retail projects that provide high-quality food in areas with low food access.

Assist in the improvement in diversity, quality, and affordability of the food products that smaller providers sell.

Support food sovereignty. The voices and aspirations of neighborhood residents need to be reflected in solutions to hunger and poor nutrition. Too often policy decisions are made without the meaningful participation of the people affected by the problem. Efforts to organize and inform residents are necessary so that they have the tools to make informed decisions about food system failures. Examples of concerns include working conditions, pay and career advancement, accountability, and opportunities for local wealth creation and employment.

Food policy councils at the municipal, regional, and state level need to be supported.

5. Ensure workplace justice for workers throughout the food chain. Workers in the restaurant industry, for example, experience unsafe working conditions. The pay is often less than that needed to feed a family. And women and people of color are disproportionately represented in lower-paid positions9.

6. Address persistent poverty by engaging multiple sectors. Governmental agencies with responsibilities for health, housing, transportation, education, nutrition, employment, the environment, and other sectors must identify and implement actions to eliminate persistent poverty. People living in such places need to act collectively, through organized intentional actions, to achieve a fair distribution of society’s resources.